Chest
Volume 132, Issue 5, November 2007, Pages 1608-1614
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Global Medicine
Socioeconomic Status and Lung Function

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Poverty is a major social problem in the United States and throughout much of the world. Poverty and the broader term socioeconomic status (SES) are important determinants of overall health status and many pulmonary diseases. The purpose of this study was to review the medical literature from the past 20 years addressing the relationship between SES and lung function in both children and adults. There is a significant negative correlation between lung function (primarily FEV1 and FVC) and SES. This relationship exists even after adjusting for smoking status, occupational exposures, and race. The magnitude of the effect of low SES on lung function is variable, but FEV1 reductions of > 300 mL in men and > 200 mL in women have been reported. SES is an important determinant of lung function and an underrecognized contributor to pulmonary disease.

Section snippets

Effects of SES on Lung Function

The most recent comprehensive review of the effects of SES on lung function was authored by Steinberg and Becklake in 1986.9 Since the mid-1980s, 14 studies1011121314151617181920212223 involving 125,253 adults and 6 studies242526272829 involving 18,477 children have examined the effects of SES on pulmonary function. These are summarized in Table 1(adults) and Table 2(children).

With the exception of a single study11 that assessed the effects of SES on diffusing capacity for carbon monoxide (Dlco

Effects of SES on Lung Function in Patients With Specific Pulmonary Diseases

Lower SES has an adverse effect on lung function in patients with cystic fibrosis and COPD. There is only limited evidence that SES has a deleterious effect on lung function in asthma patients. Two large registry studies3637 involving > 23,000 patients each examined the effect of SES on lung function in patients with cystic fibrosis. Schechter et al36 used Medicaid status as a proxy for low SES. The percent predicted FEV1 for patients receiving Medicaid was 9.1% less than that for non-Medicaid

How Does Low SES Affect Lung Function?

The fact that SES is associated with reduced lung function in male and female patients at all ages and in countries with markedly different standards of living and environmental exposures suggests multifactorial origins. While it is not entirely clear how poverty in particular and lower SES in general affect lung function, economic conditions have some commonalities with known risks. Table 3lists several factors that may explain the link between SES and reduced lung function. As discussed

Conclusion

Poverty and the broader term SES are associated with illness, disability, and premature death.1 The relationship is continuous; the richer one is, the less likely he or she is to experience poor health. As in cardiac disease, cancer, and strokes, there is an inverse relationship between social class and pulmonary disease in general, and more specifically lung function.65 Both spirometry measures (FEV1 and FVC) and Dlco are reduced with low SES. The magnitude of this effect is variable, but FEV1

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    The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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